SavedAdd your journal

Journals / Uludağ Üniversitesi Tıp Fakültesi Dergisi / 2025 / Cilt: 52

Where do Glucocorticoids and Nonsteroidal Anti-Inflammatory Drugs Stand in the Treatment of Rheumatoid Arthritis in The Biologic Era?

Biyolojik Tedavi Çağında Romatoid Artrit Tedavisinde Glukokorttikoidler ve Nonsteroid Antiinflamatuvar İlaçların Yeri Nedir?

Belkis Nihan Coskun(Bursa Uludag University Faculty of Medicine, Division of Rheumatology, Bursa, Türkiye.)0000-0003-0298-4157
Burcu Yağız(Bursa Uludag University Faculty of Medicine, Division of Rheumatology, Bursa, Türkiye.)0000-0002-0624-1986
Firdevs Ulutaş(Pamukkale University Faculty of Medicine, Division of Rheumatology, Denizli, Türkiye.)0000-0001-8441-5219
Yavuz Pehlivan(Bursa Uludag University Faculty of Medicine, Division of Rheumatology, Bursa, Türkiye.)0000-0002-7054-5351
Hüseyin Ediz Dalkılıç(Bursa Uludag University Faculty of Medicine, Division of Rheumatology, Bursa, Türkiye.)0000-0001-8645-2670
Pages
—
Publication Date
2026-07-08
🏛️Bibliographic metadata and full text access for this article are provided via DergiPark.
DergiPark Record ↗
✨

AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Prospective studies evaluating cumulative drug exposure and long-term outcomes are needed to better define the role of symptomatic therapies in modern RA management.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:This study aimed to evaluate the frequency of nonsteroidal anti-inflammatory drug (NSAID) and glucocorticoid (GC) use and their association with disease activity in patients with rheumatoid arthritis (RA).
📊
Key Findings & Data:A total of 686 patients fulfilling the 2010 European League Against Rheumatism (EULAR) classification criteria for RA were included.
💡
Conclusion & Impact:Prospective studies evaluating cumulative drug exposure and long-term outcomes are needed to better define the role of symptomatic therapies in modern RA management.
🔬Design:Araştırma Makalesi
📍Scope:2010 Verileri
⚙️Variables:Glukokortikoidler · nonsteroidal antiinflamatuar ilaçlar · romatoid artrit.

Abstract

This study aimed to evaluate the frequency of nonsteroidal anti-inflammatory drug (NSAID) and glucocorticoid (GC) use and their association with disease activity in patients with rheumatoid arthritis (RA). A total of 686 patients fulfilling the 2010 European League Against Rheumatism (EULAR) classification criteria for RA were included. Patients were categorized into four groups according to symptomatic therapy exposure: no NSAID/GC use, GC use only, NSAID use only, and combined NSAID and GC use. Disease activity and functional status were assessed using DAS28, HAQ, VAS, and inflammatory markers. Significant differences were observed among the groups with respect to disease duration, DAS28, HAQ, VAS, and CRP levels (p < 0.05). The combined NSAID and GC group represented the largest proportion of patients. Rheumatoid factor (RF) and anti-CCP positivity rates did not differ significantly between groups. Most patients did not report severe adverse events, with gastrointestinal symptoms and weight gain being the most frequently reported side effects. In this real-world cohort, symptomatic therapies remained commonly used despite the widespread availability of biologic treatments. Combined NSAID and GC use was associated with differences in disease activity measures; however, the observational design of the study precludes causal inference. Prospective studies evaluating cumulative drug exposure and long-term outcomes are needed to better define the role of symptomatic therapies in modern RA management.

Özet

Bu çalışma, romatoid artrit (RA) hastalarında steroid olmayan antiinflamatuar ilaç (NSAID) ve glukokortikoid (GC) kullanım sıklığını ve hastalık aktivitesiyle ilişkisini değerlendirmeyi amaçlamıştır. 2010 Avrupa Romatizma Birliği (EULAR) RA sınıflandırma kriterlerini karşılayan toplam 686 hasta çalışmaya dahil edilmiştir. Hastalar semptomatik tedaviye maruz kalmalarına göre dört gruba ayrılmıştır: NSAID/GC kullanımı yok, sadece GC kullanımı, sadece NSAID kullanımı ve NSAID ve GC kombinasyonu kullanımı. Hastalık aktivitesi ve fonksiyonel durum DAS28, HAQ, VAS ve inflamatuar belirteçler kullanılarak değerlendirilmiştir. Gruplar arasında hastalık süresi, DAS28, HAQ, VAS ve CRP düzeyleri açısından anlamlı farklılıklar gözlemlenmiştir (p < 0,05). NSAID ve GC kombinasyonu kullanan grup, hastaların en büyük oranını temsil etmiştir. Romatoid faktör (RF) ve anti-CCP pozitiflik oranları gruplar arasında anlamlı farklılık göstermedi. Hastaların çoğu ciddi yan etkiler bildirmedi; en sık bildirilen yan etkiler gastrointestinal semptomlar ve kilo artışıydı. Bu gerçek dünya kohortunda, biyolojik tedavilerin yaygın olarak bulunmasına rağmen semptomatik tedaviler yaygın olarak kullanılmaya devam etti. Kombine NSAID ve GC kullanımı, hastalık aktivitesi ölçümlerinde farklılıklarla ilişkilendirildi; ancak çalışmanın gözlemsel tasarımı nedensel çıkarım yapmayı engellemektedir. Semptomatik tedavilerin modern RA yönetimindeki rolünü daha iyi tanımlamak için kümülatif ilaç maruziyetini ve uzun vadeli sonuçları değerlendiren prospektif çalışmalara ihtiyaç vardır.

🔖

Cite This Article

Coskun, B. N., Yağız, B., Ulutaş, F., Pehlivan, Y., Dalkılıç, H. E., *, B. N. C. (2026). Where do Glucocorticoids and Nonsteroidal Anti-Inflammatory Drugs Stand in the Treatment of Rheumatoid Arthritis in The Biologic Era?. Uludağ Üniversitesi Tıp Fakültesi Dergisi, Cilt: 52. https://doi.org/10.32708/uutfd.1918632

📄 Full Text PDF Viewer

📄

PDF görüntüleyici hazırlanıyor...

References (32)

  1. Brus H, van de Laar M, Taal E et al. Determinants of compliance with medication in patients with rheumatoid arthritis: the importance of self-efficacy expectations. Patient Educ Couns. 1999;36:57-64.
  2. Garcia Popa-Lisseanu MG, Greisinger A, Richardson M et al. Determinants of treatment adherence in ethnically diverse, economically disadvantaged patients with rheumatic disease. J Rheumatol. 2005;32:913-919.
  3. Möttönen T, Hannonen P, Leirisalo-Repo M et al. Comparison of combination therapy with single-drug therapy in early rheumatoid arthritis: a randomised trial. FIN-RACo Trial Group. Lancet 1999;353:1568-73.
  4. Grigor C, Capell H, Stirling A et al. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. Lancet 2004;364:263-9.
  5. Hetland ML, Stengaard-Pedersen K, Junker P et al. Aggressive combination therapy with intra-articular glucocorticoid injections and conventional disease-modifying anti-rheumatic drugs in early rheumatoid arthritis: second-year clinical and radiographic results from the CIMESTRA study. Ann Rheum Dis. 2008;67:815-22.
  6. Smolen JS, Aletaha D, Bijlsma JW et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010;69:631-7.
  7. Smolen JS, Landewe R, Bergstra SA et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023;82(1):3-18.
  8. Iwami RS, Moura MD, Sorrilha FB, Bergamaschi C. Effectiveness and safety of oral corticosteroids in the treatment of rheumatoid arthritis: a systematic review. Rev Bras Farmácia Hosp e Serviços Saúde. 2022;13(1):0749.
  9. Ivanova LV, Akulinushkina EY, Vedekhina AN et al. Steroid-sparing effect of levilimab in rheumatoid arthritis in real practice. Терапевтический архив. 2025;97(4):329-335.
  10. P. Madureira, S. Pimenta, R. Vieira et al. AB0504 The Role of Corticosteroids in Rheumatoid Arthritis Patients Under Biologic Therapy. Ann Rheum Dis; 2015:1067.
  11. B. Barac, A. Zekovic, T. Divljakovic et al. AB0497 The Role Of Corticosteroids (Prednisone) In The Treatment Of Newly Diagnosed Rheumatoid Arthritis. Ann Rheum Dis; 2023:1443.
  12. Rau R. Glucocorticoid treatment in rheumatoid arthritis. Expert Opin Pharmacother. 2014;15(11):1575-83.
  13. Mercieca C, Kirwan JR. The intelligent use of systemic glucocorticoids in rheumatoid arthritis. Expert Rev Clin Immunol. 2014;10(1):143-57.
  14. Paglia MDG, Silva MT, Lopes LC et al. Use of corticoids and non-steroidal antiinflammatories in the treatment of rheumatoid arthritis: Systematic review and network meta-analysis. PLoS ONE. 2021;16(4):e0248866.
  15. Pongparadee C, Penserga E, Lee DJS et al. Current considerations for the management of musculoskeletal pain in Asian countries: a special focus on cyclooxygenase-2 inhibitors and non-steroid anti-inflammation drugs. Int J Rheum Dis. 2012;15:341-347.
  16. Bergstra SA, Sepriano A, Kerschbaumer A, van der Heijde D, Caporali R, Edwards CJ et al. Efficacy, duration of use and safety of glucocorticoids: a systematic literature review informing the 2022 update of the EULAR recommendations for the management of rheumatoid arthritis. Ann Rheum Dis 2023;82(1):81-94.
  17. Kyburz D, Finckh A. The importance of early treatment for the prognosis of rheumatoid arthritis. Swiss Med Wkly. 2013;143:w13865.
  18. Demoruelle MK, Deane KD. Treatment strategies in early rheumatoid arthritis and prevention of rheumatoid arthritis. Curr Rheumatol Rep. 2012;14(5):472-80.
  19. De Cock D, Van der Elst K, Meyfroidt S et al. The optimal combination therapy for the treatment of early rheumatoid arthritis. Expert Opin Pharmacother. 2015;16(11):1615-25.
  20. Leirisalo-Repo M. What is the best treatment strategy for early RA? Best Pr Res Clin Rheumatol. 2013;27(4):523-36.
  21. Bijlsma JW, Jacobs JW. Glucocorticoids in the treatment of rheumatoid arthritis: still used after 65 years. Ann N Y Acad Sci. 2014;1318:27-31.
  22. Hetland ML. Modern treatment strategies in rheumatoid arthritis, Impact on, and predictors of, disease activity and disease course. Dan Med Bull. 2011;58(11):B4320.
  23. Kuusalo L, Puolakka K, Kautiainen H et al. Impact of physicians’ adherence to treat-to-target strategy on outcomes in early rheumatoid arthritis in the NEO-RACo trial. Scand J Rheumatol. 2015;44(6):449-55.
  24. Bahtsevani C, Uden G, Willman A. Outcomes of evidence-based clinical practice guidelines: a systematic review. Int J Technol Assess Heal Care. 2004;20:427–33.
  25. Didomenico RJ, Perez A, Schumann HM et al. Impact of treatment guidelines on clinical and economic outcomes of acute decompensated heart failure. Ann Pharmacother. 2008;42:327–33.
  26. Patel GW, Roderman N, Gehring H et al. Assessing the effect of the surviving sepsis campaign treatment guidelines on clinical outcomes in a community hospital. Ann Pharmacother. 2010;44:1733–8.
  27. Oh SW, Lee HJ, Chin HJ et al. Adherence to clinical practice guidelines and outcomes in diabetic patients. Int J Qual Heal Care. 2011;23:413–19.
  28. Kirwan JR. The effect of glucocorticoids on joint destruction in rheumatoid arthritis. The Arthritis and Rheumatism Council Low-Dose Glucocorticoid Study Group. N Engl J Med. 1995;333(3):142-6.
  29. Pincus T, Sokka T, Stein CM. Are long-term very low doses of prednisone for patients with rheumatoid arthritis as helpful as high doses are harmful? Ann Intern Med. 2002;136(1):76-8.
  30. Smolen JS, Landewé R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis. 2014; 73(3):492-509. doi:10.1136/annrheumdis-2013-204573
  31. Caplan L, Wolfe F, Russell AS, Michaud K. Corticosteroid use in rheumatoid arthritis: Prevalence, predictors, correlates, and outcomes. J Rheumatol 2007;34:696-705.
  32. Saag KG. Low-dose corticosteroid therapy in rheumatoid arthritis: balancing the evidence. Am J Med. 1997;103(6A):31S-39S.